Pharm Flashcards
How has Strep. Pneumoniae developed resistance to penicillin? What drug could you treat it with?
Similar to Staph A.
Strep. Pneumo-PBP has decreased affinity for penicillin
Treat with vancomycin
You have a patient present with fever, nuchal rigidity, and headache that has markedly turbid CSF upon lumbar puncture. Gram stain shows a G + bile soluble bacteria. Patient also has elevated levels of TNF-alpha. How should you begin their treatment, and how should you appropriately de-escalate their treatment.
A) Ceftriaxone + Dexamethasone then drop Dexa
B) Ceftriaxone + Vancomycin + Dexamethasone then drop Vancomycin if its not a resistant strain
C) Vancomycin + Ampacillin then drop Amp if no listeria
D) Vancomycin + Dexamethasone then drop Dexa as inflammation subsides.
B is correct- This is Strep Pneumo which can be resistant to ceftriaxone, which is why you treat with vancomycin just in case. If its found to be sensitive then you don’t need the vancomycin. You may also end up droping the dexamethasone when inflammation subsides, but you want to make sure you still have high concentrations of your drug in the CSF even after inflammation decreases; making penitration into the CSF more difficult.
A could be correct if the strain was not resistant and inflammation decreased, but because of the likelyhood of strep pneumo resistance you need to treat initially a theoretically resistant strain, until you know otherwise.
C is not indicated because listeria is not suspected
D don’t forget ceftriaxone for sensitive strains, lets not encourage vancomycin resistance, by using it too much.
For which of the following is antibiotic prophylaxis not required for close contacts of someone who is being treated for meningitis?
A) N. meningitidis
B) H. influenzae
C) Strep. pneumoniae
C is correct
What drug can treat viral encephalitis? How does it work? How do you dose?
What about rickettsial or ehrlichial infection ?
Acyclovir- acts like a werid Nucleotide that gets integrated by a viral polymerase of HSV and acts as a chain terminator.
Dose based on ideal weight-doesn’t pen. fat well
Doxycycline
Your patient has a form of Gram - meningitis. How might this alter your drug therapy?
A) Don’t use vancomycin
B) Don’t use ceftriaxone
C) Don’t use dexamethazone
D) Don’t use lumbar puncture
A-vancomycin is used for gram + infections
B- ceftriaxone works on gram - N. meniginidis, H. influenza
C-inflammation will still happen
D- still needs to happen
What AED should you take for a partial seizure, including one with secondary generalization? What are some alternatives?
Carbamazepine or phenytoin
Alternatively- levetiracetam or valproic acid
What drugs should you use to treat a typical absence seizure? What are some alternatives?
Ethosuximide
Alternative- valproic acid
What drug should you use to treat myoclonic seizure?
Valproic acid
What type of AED should you use to treat Clonic or Tonic seizure? Whats an alternative?
Valproic acid
Alternative-Phenytoin
What AED would you administer for Tonic-conic seizure?
Carbamazepine, or pheytoin, or valproic acid
What AED do you use for status epilepticus preferentially, and what are some alternatives?
Lorazepam or diazepam, followed by pheytoin
Alternatives-Phenytoin or phenobarbital
